Author: Jason Curtis

Clinical Orthopaedic Teaching programme for Students (COTS) (2020)

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Type of publication:
Journal article

Author(s):
Kumar P.R.; Stubley T.; Hashmi Y.; *Ahmed U.

Citation:
Postgraduate Medical Journal; 2020 [epub ahead of print]

Abstract:
Introduction: There is a huge variation in the depth and breadth of content taught regarding orthopaedic examinations. Undergraduate students are often confused by the variability in examination teaching, therefore increasing concerns for upcoming objectively structured clinical examinations (OSCEs). Doctors, despite being expected to teach, rarely receive formal preparation, with only a handful of institutions providing necessary training. The Clinical Orthopaedic Teaching programme for Students (COTS) was designed to equip medical students with the knowledge to perform orthopaedic examinations and to synergistically provide senior students with the necessary experience for the future teaching required of them. Method(s): Six fortnightly sessions were delivered, each focusing on a specific joint examination. Student and tutor recruitment were voluntary. Pre-session and post-session multiple-choice questions (MCQs) were provided to students to assess improvement in knowledge. Anonymous feedback forms were provided to both students and tutors. Result(s): From 61 student responses, 98.4% of students stated that COTS met the learning outcomes, with content relevant for their medical curriculum. 96.7% supported COTS' near-peer teaching (NPT) style for OSCE preparation. Based on a five-point Likert scale, students displayed a mean improvement in confidence (1.7+/-1.2, p<0.001) and MCQ scores (1.3+/-1.2, p<0.001). All 10 tutors perceived an improvement of their teaching skills and confidence to teach (1.0+/-0.9, p=0.016). Conclusion(s): COTS shows that an NPT style can be used to effectively teach orthopaedic examinations, with benefits for students and tutors. With our aim to refine and upscale this programme, we publish our pilot study findings to encourage similar teaching programmes to be adopted at other universities.

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Lessons of the month: Co-infection with SARS-CoV-2 and influenza B virus in a patient with community-acquired pneumonia (2020)

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Type of publication:
Journal article

Author(s):
*Coutinho A.; *Riaz A.; *Makan A.; *Crawford E.; *Dev D.; *Srinivasan K.; *Ahmad N.; *Moudgil H.

Citation:
Clinical medicine (London, England); Nov 2020; vol. 20 (no. 6); e262–3

Abstract:
Why we only infrequently detect or report two or more respiratory viruses co-infecting an adult host is poorly understood. We report a rare case where influenza B and SARS-CoV-2 caused viral pneumonia in a 74-year-old man diagnosed during the UK winter epidemic/pandemic for these organisms and discuss concepts of co-infection.

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Exploring the emotional experience of lean (2020)

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Type of publication:
Journal article

Author(s):
Taylor S.; McSherry R.; *Cook S.; Giles E.

Citation:
Journal of health organization and management; Nov 2020 [epub ahead of print]

Abstract:
PURPOSE: This research aims to contribute to the literature on Lean implementation in healthcare by studying the emotional experiences of the relevant actors related to a Rapid Process Improvement Workshop (RPIW) in a UK healthcare context. The purpose of this study was to go beyond what people think about Lean and towards an exploration of their subjective, emotional and "feeling" experience and whether that emotional experience influenced Lean implementation. DESIGN/METHODOLOGY/APPROACH: A phenomenological and symbolic interactionist qualitative case study was undertaken. Data related to participants' emotional experience were collected through non-participant observation and semi-structured interviews. Data were analysed using thematic network analysis. FINDINGS: This paper provides novel insights into the emotional experience of Lean as experienced through an RPIW. The findings reveal that participation in an RPIW is much more than a technical process. It influences how people feel about themselves, is based on relationships with others, and requires mental, physical and emotional effort. All of these factors influence engagement with, initiation of and sustainability of the RPIW. RESEARCH LIMITATIONS/IMPLICATIONS: A new conceptual framework for the planning and implementation of RPIWs has been developed. However, because of the chosen research approach, the results may lack generalisability. Therefore, researchers are encouraged to test the framework and proposed practice implications. ORIGINALITY/VALUE: Despite emotions being an integral part of individual and social everyday life, emotional experience has not been studied in relation to Lean. This study is the first to explore emotions in relation to Lean, with implications for practice as to how RPIWs are managed with a new framework for implementation being proposed.

Emotional distress and adjustment in patients with end-stage kidney disease: A qualitative exploration of patient experience in four hospital trusts in the West Midlands, UK (2020)

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Type of publication:
Journal article

Author(s):
Sein K.; Damery S.; Combes G.; Baharani J.; *Nicholas J.

Citation:
PLoS ONE; Nov 2020; vol. 15 (no. 11)

Abstract:
Objectives To explore patient perceptions and experiences of mild-to-moderate emotional distress and the support offered by kidney units to patients with end-stage kidney disease. Methods In-depth, semi-structured qualitative interviews with patients (n = 46) being treated for endstage kidney disease in four hospital Trusts, with data analysed thematically. Results Patients described multiple sources of distress and talked about the substantial burden that emotional challenges raised for their ability to manage their condition and develop coping strategies. Many patients did not feel it appropriate to disclose their emotional issues to staff on the kidney unit, due to a perceived lack of time for staff to deal with such issues, or a perception that staff lacked the necessary skills to provide resolution. Five themes were identified from the patient interviews, broadly related to patients' experience of distress, and the support offered by the kidney unit: I) the emotional burden that distress placed on patients; ii) patients' relationship with the treatment for their condition; iii) strategies for coping and adjustment; iv) patient-staff interactions and the support offered by the kidney unit, and v) the mediating impact of the treatment environment on patient experience of distress and their ability to raise emotional issues with staff. Conclusions Many patients felt unprepared for the likelihood of experiencing emotional issues as part of their condition, for which pre-dialysis education could help in managing expectations, along with support to help patients to develop appropriate coping strategies and adjustments. These findings demonstrate the importance of recognising patient distress and ensuring that talking about distress becomes normalised for patients with end-stage kidney disease.

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Hypertension in COPD: A review of current practice (2020)

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Type of publication:
Poster presentation

Author(s):
*Richard Cooper, *Wong Po Fung, *Alison Perry, *James Greenway, *Harmesh Moudgil, *Koottalai Srinivasan, *Annabel Makan, *Emma Crawford, *Nawaid Ahmad

Citation:
European Respiratory Journal 2020; 56: Suppl. 64, 184.

Abstract:
Background: Patients with COPD are susceptible to cardiovascular events and a recent review article has outlined management of Hypertension in the COPD population [Finks S et al. N Engl J Med 2020;382:353-63]. It is not known how the authors’ suggestions translate into practice, so review was undertaken of a UK District General Hospital population.
Aims: The aim was to review management of hypertensive COPD patients; choice of anti-hypertensive medication, and correlations with morbidity and mortality
Methods: This was a retrospective analysis of all COPD patients who presented to hospital with an exacerbation between October and December 2019. Patients without a history of hypertension were excluded.
Results: 151 patients were admitted during this period. 71/151 were known hypertension. 52% were female, Mean Age (SD) 74 (10) years. 83% (n=59/71) were on anti-hypertensive medication/s (AH) of which 44% (n=26/59), 42% (n=25/59), 12% (7/59) and 2% (1/59) were on one, two, three and four AH respectively. 42% (30/71) patients had an exacerbation in the last 12 months and 97% (29/30) were on ≥1 AH. Unadjusted 30 day mortality was 11% (n=8/71) of which 88% (7/8) were on ≥1 AH. n=2/3 patients on beta blockers, n=2/5 on angiotensin receptor blockers (ARB), n=6/12 on calcium channel blockers (CCB), n=3/4 on ACE-inhibitors and 1/1 on Alpha blocker as a single AH had an exacerbation in the last 12 months. More patients on loop diuretics (LD) had chronic type 2 respiratory failure (n=5) or exacerbations in the last 12 months (n=10).
Conclusions:
1.CCB is the most commonly used AH agent
2.Patients on ARBs were least likely to exacerbate
3.LD may contribute to more exacerbations and chronic type 2 respiratory failure

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Sex differences in cardiovascular morbidity associated with familial hypercholesterolaemia: A retrospective cohort study of the UK Simon Broome register linked to national hospital records (2020)

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Type of publication:
Journal article

Author(s):
Barbara Iyen, Nadeem Qureshi, Stephen Weng, Paul Roderick, Joe Kai, *Nigel Capps, Paul N. Durrington, Ian FW. McDowell, Handrean Soran, Andrew Neil, Steve E. Humphries

Citation:
Atherosclerosis, 2020 Dec;315:131-137

Abstract:
Background and aims: The UK Simon Broome (SB) familial hypercholesterolaemia (FH) register previously reported 3-fold higher standardised mortality ratio for cardiovascular disease (CVD) in women compared to men from 2009 to 2015. Here we examined sex differences in CVD morbidity in FH by national linkage of the SB register with Hospital Episode Statistics (HES).
Methods: Of 3553 FH individuals in the SB register (aged 20–79 years at registration), 2988 (52.5% women) had linked HES records. Standardised Morbidity Ratios (SMbR) compared to an age and sex-matched UK general practice population were calculated [95% confidence intervals] for first CVD hospitalisation in HES (a composite of coronary heart disease (CHD), myocardial infarction (MI), stable or unstable angina, stroke, TIA, peripheral vascular disease (PVD), heart failure, coronary revascularisation interventions).
Results: At registration, men had significantly (p < 0.001) higher prevalence of previous CHD (24.8% vs 17.6%), previous MI (13.2% vs 6.3%), and were commenced on lipid-lowering treatment at a younger age than women (37.5 years vs 42.3 years). The SMbR for composite CVD was 6.83 (6.33–7.37) in men and 7.55 (6.99–8.15) in women. In individuals aged 30–50 years, SMbR in women was 50% higher than in men (15.04 [12.98–17.42] vs 10.03 [9.01–11.17]). In individuals >50 years, SMbR was 33% higher in women than men (6.11 [5.57–6.70] vs 4.59 [4.08–5.15]).
Conclusions: Excess CVD morbidity due to FH remains markedly elevated in women at all ages, but especially those aged 30–50 years. This highlights the need for earlier diagnosis and optimisation of lipid-lowering risk factor management for all FH patients, with particular attention to young women with FH.

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Emotional Resilience and Bariatric Surgical Teams: a Priority in the Pandemic (2021)

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Type of publication:
Journal article

Author(s):
Graham, Yitka; Mahawar, Kamal; *Riera, Manel; Islam, Omar; Bhasker, Aparna Ghovil; Wilson, Michael; Tahrani, Abd; Moize, Violeta; Leal, Angela; Hayes, Catherine

Citation:
Obesity Surgery; Apr 2021; vol. 31 (no. 4); p. 1887-1890

Abstract:
The infection control measures implemented as a result of COVID-19 led to a postponement of bariatric surgical procedures across many countries worldwide. Many bariatric surgical teams were in essence left without a profession, with many redeployed to other areas of clinical care and were not able to provide the levels of patient support given before COVID-19. As the pandemic continues, some restrictions have been lifted, with staff adjusting to new ways of working, incorporating challenging working conditions and dealing with continuing levels of stress. This article explores the concept of emotional labour, defined as 'inducing or suppressing feelings in order to perform one's work', and its application to multidisciplinary teams working within bariatric surgery, to offer insight into the mental health issues that may be affecting healthcare professionals working in this discipline.

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The knowledge attitude and practice (KAP) of mothers of asthmatic children toward asthma in Khartoum asthma clinics (2020)

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Type of publication:
Journal article

Author(s):
Noureddin A.A.; Shaaban K.M.; Mohamed S.O.O.; Mahmoud A.A.A.; *Salman M.S.T.; *Abdalla A.A.

Citation:
Scientific reports; Aug 2019; vol. 9 (no. 1); p. 12120

Abstract:
Prevention of asthma attacks is one of the major challenges of public health. Sufficient knowledge and positive attitudes and correct practices are crucial for the prevention of exacerbations. However, there is insufficiency of information in regard to these in Sudan. The aim of this study was to assess the knowledge and to identify the attitude and practice of mothers of asthmatic children concerning their use of inhalers, compliance to preventers and to measure its effect on the severity of the disease in their children. A sample of 100 consecutive mothers of asthmatic children was enrolled. Any mother with a child diagnosed with bronchial asthma for more than 3 months, and who attended the outpatient clinic of paediatric asthma in Soba or Ahmed Gasim hospitals or the Emergency room of Ahmed Gasim or Ibrahim Malik hospital in the period from 1st to 31st of October 2016 was eligible to be included. Asthma was believed to be infectious by 7% of the respondents. 17% of the mothers thought asthma was preventable by a vaccine. 21% found inhaler use unacceptable. Half of the mothers (50%) did not use the inhaler correctly. Most of the mothers (69%) did not use the inhaler if symptoms were mild and 53% didn't use preventers. The severity of asthma was found to be significantly associated with the attitude and practice of mothers (P<0.05). In conclusion, sustained efforts are required to increase knowledge about all dimensions of asthma and its management among patients and to disperse myths and misguided judgments regarding the disease and its treatment.

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Nutritional status and predictors of weight loss in patients with systemic sclerosis (2020)

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Type of publication:
Journal article

Author(s):
Hvas C.L.; Eriksen M.K.; *Harrison E.; Herrick A.L.; McLaughlin J.T.; Lal S.

Citation:
Clinical Nutrition ESPEN; Volume 40, December 2020, Pages 164-170

Abstract:
Background & aims: Systemic sclerosis (SSc) commonly affects the gastrointestinal (GI) tract and predisposes to malnutrition. Few studies assessed body composition in outpatients with SSc or used more than one method for comparison over time. The aim of this study was to describe markers of nutrition and body composition in patients with SSc and to identify predictors of unintentional weight loss. Method(s): We consecutively included outpatients with SSc and performed a one-year follow-up. Gastrointestinal (GI) involvement was evaluated from clinical investigations. Patients completed questionnaires for organ involvement and functional status. Clinical assessment included body mass index (BMI), the malnutrition universal screening tool (MUST), inter-incisor distance, anthropometry, and bio-electrical impedance analysis (BIA). Result(s): In total, 168 consecutive patients with SSc were included, and 127 (76%) completed one-year follow-up. Thirteen (8%) died before follow-up. Based on MUST scores, 12% of patients were at high and 14% at medium risk of malnutrition. A low BMI was associated with small intestinal involvement (p < 0.0001). Percentage body fat correlated with BMI, both when using four-site anthropometry (r = 0.65, p < 0.01) and BIA (r = 0.49, p < 0.01). Nine (7%) patients had >5% unintentional weight loss at follow-up. Independent baseline predictors of unintentional weight loss included upper GI involvement and disease severity estimated by Health Assessment Questionnaire Disability Index score. Conclusion(s): Nutritional risk and GI involvement are frequent and closely correlated in patients with SSc. BIA and four-site anthropometry are comparable in the clinical assessment of patients with SSc. Unintentional weight loss is discrete and related to disease-specific characteristics.